Fein v. Permanente Medical Group
695 P.2d 665, 211 Cal. Rptr. 368, 38 Cal. 3d 137 (1985)
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Rule of Law:
The legislature has broad authority to enact tort reform measures, such as capping noneconomic damages and modifying the collateral source rule in medical malpractice cases, and these measures do not violate due process or equal protection so long as they are rationally related to a legitimate state interest, such as controlling medical insurance costs and ensuring healthcare availability.
Facts:
- In February 1976, Lawrence Fein, a 34-year-old attorney, began experiencing episodes of chest pain.
- On February 26, Fein had an appointment at Permanente Medical Group and was examined by a nurse practitioner, Cheryl Welch.
- After consulting with a supervising physician, Nurse Welch diagnosed Fein with muscle spasms and prescribed Valium.
- Early the next morning, Fein went to the Kaiser emergency room with severe chest pains, where Dr. Lowell Redding also diagnosed muscle spasms and prescribed painkillers.
- Around noon that same day, Fein returned to the emergency room with severe and constant pain.
- A different physician, Dr. Donald Oliver, ordered an electrocardiogram (EKG), which revealed Fein was suffering from an acute myocardial infarction (a heart attack).
- As a result of the heart attack, a significant portion of Fein's heart muscle was destroyed, reducing his life expectancy by approximately half.
- Fein's expert witness testified that an earlier EKG should have been ordered, and that timely treatment could have prevented or minimized the heart attack's damage.
Procedural Posture:
- Lawrence Fein filed a medical malpractice action against Permanente Medical Group in a California superior court (the trial court of first instance).
- Prior to trial, the court rejected Fein's constitutional challenge to Civil Code sections 3333.2 (noneconomic damage cap) and 3333.1 (collateral source rule modification).
- A jury found in favor of Fein and returned special verdicts awarding damages, including $500,000 for noneconomic losses.
- Following the verdict, the trial court applied section 3333.2 and reduced the noneconomic damage award to the statutory limit of $250,000.
- The court also applied section 3333.1, reducing Fein's award for past lost wages to account for disability payments he had already received.
- The trial court denied Permanente's motion to order periodic payments for future lost wages and noneconomic damages.
- Both Fein and Permanente Medical Group appealed from the final judgment to the California Supreme Court.
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Issue:
Does California Civil Code section 3333.2, which limits recovery for noneconomic damages in medical malpractice actions to $250,000, violate the due process and equal protection clauses of the state and federal constitutions?
Opinions:
Majority - Kaus, J.
No. Civil Code section 3333.2 does not violate the due process or equal protection clauses. The Legislature has broad authority to modify the scope and nature of damages, and a plaintiff has no vested property right in a particular measure of damages. The statute need only be rationally related to a legitimate state interest. Here, the Legislature enacted the Medical Injury Compensation Reform Act (MICRA) to address a perceived crisis in the rising cost of medical malpractice insurance, which threatened the availability of healthcare. Capping noneconomic damages is a rational means to reduce malpractice litigation costs. The law also survives equal protection scrutiny because the Legislature can permissibly target reforms to the specific area where it identified a crisis (medical malpractice), and the distinction between unlimited economic damages and capped noneconomic damages is a rational choice to ensure victims are fully compensated for pecuniary losses while achieving cost savings.
Dissenting - Bird, C. J.
Yes. Civil Code section 3333.2 violates the equal protection clause. The statute arbitrarily and unfairly singles out the most severely injured victims of medical negligence to bear the financial burden of providing relief to negligent healthcare providers and their insurers. This creates a fundamentally arbitrary classification that has no fair and substantial relation to the legislative goal. While insurance is intended to spread risk, this law perversely concentrates the costs of the worst injuries onto a few individuals. The majority's acceptance of broad, speculative rationales fails to conduct the 'serious and genuine judicial inquiry' required by this court's precedent in cases like Brown v. Merlo.
Dissenting - Mosk, J.
Yes. The statutory cap is unconstitutional. While agreeing with the Chief Justice's conclusion, this dissent argues that the court should abandon the rigid two-tier equal protection analysis and adopt an intermediate level of scrutiny. Under an intermediate test, a court would assess whether the challenged classification has a fair and substantial relation to the legislative objective and whether the restriction on private rights outweighs the public benefit. This case demonstrates the need for a more flexible standard than the highly deferential rational basis test applied by the majority.
Analysis:
This decision, along with its companion cases, solidified the constitutionality of California's landmark Medical Injury Compensation Reform Act (MICRA). It firmly established that the legislature possesses broad power to enact significant tort reform in response to a perceived social or economic crisis, provided the reforms pass the highly deferential rational basis review. The ruling confirmed that common law tort remedies are not constitutionally protected from legislative modification and has had a profound and lasting impact on medical malpractice litigation in California, serving as a key precedent for upholding similar reforms nationwide.
